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Business System Analyst Resume

Buffalo New, YorK

PROFESSIONAL SUMMARY:

  • 6+ years of IT experience in Data Analyst with extensive usage of SQL, Tableau and HP ALM/QC.
  • Good understanding of SDLC and STLC methodologies including Waterfall, Iterative, Agile and Scrum methodologies.
  • Good experience in data sources, data profiling, data validation, developing low level design patterns based on the business and functional requirements.
  • In a data warehouse environment, designed the staging area based on OLTP concepts, cleansed and profiled before loading into data marts.
  • Experienced in gathering requirements for HIPPA (Health Insurance Portability and Accountability Act) EDI (Electronic Data Interchange) Transactions 820, 834, 835, 837 (I, P and D), 270, 271, 276, 277, 278, 997 and 999 in various phases of implementation.
  • Expertise in creating various artifacts like BRDs, Functional Specs, Used Cases, Data Mapping Documents, Test Plans and Test Strategies, pre and post RTMs and Status Weekly Reports etc.
  • Strong visual modeling and Business Process Modeling (BPM) skills using Rational Unified Process (RUP) with tools like Rational Rose, and MS Visio.
  • Excellent analytical, organizational, communication and documentation skills along with good project management skill to gather requirements to bring out the quality product.
  • Knowledge in Data Modelling, Data Extraction, Transformations and Loading, Mappings Workflows, and Customized Analytics Reports.
  • Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
  • Skilled and managing the breakdown of the Epics in the product backlog into user stories that abide by the invest criteria
  • Extensive experience in Healthcare/Claims and encounters adjudication with knowledge of industry compliance standards like HIPAA and EDI X12 transactions (834, 837, 835, 270/271, 276/277).
  • Experience in Healthcare/Claims adjudication with knowledge of industry compliance standards like EDI X12 transactions (834, 835, 837, 270/271, and 276/277) and NCPDP formatted Encounter claims.
  • Well - versed in MS Visio, MS Project, Mockup screen, and Microsoft suite (Word, Excel, Access, Visio, Power Point, and Outlook) for analysis and presentation
  • Facilitated User Acceptance Testing (UAT)and test strategies with developers and testers, and participated in manual front-end testing to check all functionalities of different modules

TECHNICAL SKILLS:

Business Skills: Business Process Analysis & Design, Gap Analysis, Impact Analysis, JAD Sessions, Requirement Gathering, and Use Case Modeling

Languages: SQL, HTML XML

Database: MS SQL Server, Oracle, MS Access

Project Management: Microsoft Project

SDLC Methodologies: Agile Scrum, Waterfall, Hybrid

Operating Systems: Windows, UNIX

Other Tools: MS SharePoint, MS Visio, HP ALM/QC, MS Office, FACETS

ETL Tool: Informatica Power Center

BI & Reporting Tool: Tableau

PROFESSIONAL EXPERIENCE:

Confidential, Buffalo, New York

Business System Analyst

Responsibilities:

  • Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
  • Matched the requirements for programs such as Medicare and Medicaid, which are part of the Social Security Act.
  • Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in Rational Rose for the Business Use Case and System Use Case.
  • Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277, 835, 834 EDI transactions.
  • Generated a streamline process to understand the various steps in the loan lifecycle and desired functionality of the new system by interacting with users, management, SME (Subject Matter Expert), stakeholders, lenders, underwriters.
  • Participated in changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
  • Worked on the Patient Management System (integrated version of Patient Information System with EMR/EHR)) is intended to remotely communicate with a compatible pulse generator from BSC CRM and transfer data to a central database (HIT EHR).
  • Conducted brainstorming sessions with the business users and SMEs to elicit requirements and worked in the creation of Agile Epics, user stories, Acceptance criteria documents.
  • Extracted data by running SQL queries, and reviewed securities, financial and customer metadata that gets populated on the web application.
  • Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834 transactions.
  • Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
  • Led the development of a program to train users on a custom web application and a Cognos ad-hoc reporting environment.
  • Trained the team on JIRA tool for Agile/ Scrum Methodologies and Worked with ETL groups and Acquisition team and business analyst for understating mappings for dimensions and facts
  • Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
  • Gained in-depth knowledge and experience in pricing, inventory, procurement, time & attendance, barcode, EFT, credit cards, and handheld wireless technology in mainframe, client/server and web based environments.
  • Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
  • Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
  • Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations
  • Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
  • Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes, Claims Process, Health information Exchange (HIE), Electronic Health Record (EHR) and Electronic Medical Record (EMR
  • Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
  • Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.

Confidential, NJ

Business System Analyst

Responsibilities:

  • Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare-Medicaid, HIPPA, HIX on EPIC software applications
  • Expertise in writing SQLQueries using Oracle, SQL Server and Teradata in validating data into Data Warehouse/ETL applications.
  • Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment.
  • Facets Conversion files development. Development of the database objects required for the product for each table change in Facets.
  • Experience with Medicare, Medicaid and commercial insurances in HIPAA, ANSI, X12 formats including 270/271, 276,277, 278, 835, 837, 997.
  • Responsible for conducting the overall System Testing to verify operations of key FACETS modules involved in the processing of claims (including benefits), providers and members.
  • Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
  • Built business requirements into the Medicare Advantage (MA) requirements database and created the Project Requirements Document for the three functional areas
  • Worked on billing system a cash management module and enhanced the encrypting standards that are required for the application.
  • Writing Epics and user stories, managing sprints and backlog grooming, and tracking project progress in JIRA.
  • Analyzed system performance and initiated process improvement measures for mainframe and Web-based applications.
  • Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment
  • Participated in frequent agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide guidance to an agile product development process.
  • Interacted with line of business managers and coordinated the transition into the security database to assure business compliance with SOX.
  • Used JIRA to perform test management activities and Involved in extraction of data from various sources like flat files, Oracle and SQL Server. Coordinated with the ETL team to come up with processes for ETL involving Oracle/Informatics
  • Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
  • Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, Business Analysis and Modelling.
  • Involved in development of the system for data exchange from EMR, EHR to Electronic Lab Reporting Systems

Confidential, Bloomfield, CT

Data Analyst

Responsibilities:

  • Work on EDI X12 transactions, HIPAA standard transaction codes including 837, 834, 835, 270, 271, 276, 277 and perform analysis of such transactions.
  • Develop test plans based on test strategy. Created and executed test cases based on test strategy and test plans based on ETL mapping document
  • Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
  • Experience in Healthcare/Claims adjudication with knowledge of industry compliance standards like EDI X12 transactions (834, 835, 837, 270/271, and 276/277) and NCPDP formatted Encounter claims.
  • Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
  • Performed Defect Tracking and Project Tracking using Jira - Change Notification Request (CNR).
  • Ability to analyze engineering product support issues described within a bug-tracking system (JIRA) and provide guidance to other Client Services members in an advisory capacity, focusing on the quick resolution of the production
  • Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
  • Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare-Medicaid, HIPPA, HIX on EPIC software applications
  • Documented requirements associated change requests with requirements and connected requirements with Use cases.
  • Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
  • Instructed and modeled core Agile principles of collaboration, prioritization, team accountability and visibility, ensured consistent application of SCRUM methodologies across the enterprise
  • Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
  • Maintained benchmark controls to policies, company standards and contracts, performed vendor sourcing, pricing and contract negotiation, performed procurement, ensured compliance with service/joint interest contracts.
  • Trained the team on JIRA tool for Agile/ Scrum Methodologies.
  • Utilized JIRA to develop and track agile epics, stories and tasks Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
  • Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
  • Conducted daily SCRUM meetings during the Sprint Development as a part of Agile Methodology. Also captured and addressed concerns from IT to Product Management or Business Team as needed.
  • Work with CMS business owners to define their target goals and propose alternative business solutions
  • Gathered user and business requirements through open-ended discussions, brainstorming sessions and role-playing.
  • Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
  • Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.

Confidential, Louisville, KY

Business/Data Analyst

Responsibilities:

  • As part of a Scrum Team, actively participates in Story Creation, Backlog and PBI Refinement and Scrum Events (Sprint Planning, Daily Standup, Retrospective, and Reviews)
  • Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment.
  • Performed System testing of the Claims processing systems (Pricing Rules, Duplicate/Limits validation, Member Eligibility, Provider Enrollment, et al).
  • Involved in performance testing of Medicaid client server claims processing system, Medicaid MCC / MCO and Medicaid Management Information System (MMIS).
  • Worked with trading partners to implement and troubleshoot connectivity to EDI systems that included Secure FTP, FTP with PGP encryption for batch transactions and Web services for real time transactions.
  • Generate reports on admissions statistics and enrolment trends in order to continuously improve recruitment processes and provide accurate projections of expected growth
  • Experience in extensive database testing and Back End Testing using SQL queries with MySQL database Performed Manual Testing of the Application to determine ease of usability.
  • Participated in frequent agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide guidance to an agile product development process.
  • Working knowledge of implementing software development projects using methodologies such as Waterfall, Rational Unified Process, and Agile/Scrum.
  • Translated high-level requirements into high-level user stories and epics over two sprints on TFS Team Foundation Server.
  • Prepared implementation plan and negotiated agreement on EDI file specifications with Trading Partners and vendors in accordance with HIPAA guidelines.
  • Interfaced with technical staff, trading partners, Clearinghouses and internal staff including programmers on all HIPAA related information and changes.
  • Teamed up with Senior Management, Legal to formulate EDI Trading Partner Agreements in accordance with HIPAA compliancy rules.
  • Creation of multiple SSIS packages to import data from the legacy (mainframe) system, Oracle and Mongo DB to target SQL Server DB for report consumption and other use.
  • Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
  • Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
  • Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB

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